Uysal Gulsum, Tutus Sadan, Cagli Fulya, Adiguzel Cevdet
Department of Obstetrics and Gynecology, Adana Numune Training and Research Hospital, Adana, Turkey.
Department of Radiology, Kayseri Training and Research Hospital, Kayseri, Turkey.
North Clin Istanb. 2017 May 10;4(1):60-65. doi: 10.14744/nci.2017.26121. eCollection 2017.
Low pregnancy-associated plasma protein A (PAPP-A) level is associated with adverse perinatal outcomes. The purpose of this study was to evaluate relationship between umbilical cord diameter (UCD), umbilical vein and artery diameters (UVD, UAD), placental thickness, and PAPP-A level at gestational age of between 11 and 14 weeks.
UCD, UVD, UAD, and placental thickness of 246 women were assessed during ultrasound examination at between 11 and 14 weeks of gestation, as well as measurement of nuchal translucency (NT) and crown-rump length (CRL). Patients were divided into 2 groups according to PAPP-A percentile. Group 1 comprised 23 patients who had low PAPP-A (<0.44 multiple of medians [MoM], <10 percentile) and Group 2 was made up of 223 patients with PAPP-A of >0.44 MoM, >10 percentile. Calipers used for measurement were placed inner edge to inner edge of echogenic boundaries of the vessel. Largest sections of all vessels (UV and both arteries) were evaluated. Thickest part of the placenta was used for placental thickness measurement.
Narrow UCD (<4.5±0.6 mm) was associated with low PAPP-A level (p=0.02). There was no significant difference in UVD, UAD, or placental thickness between groups. There was no significant difference in gestational age, CRL, or NT between groups. Fetal birth weight was significantly lower in Group 1 (p=0.03).
Closer attention to women with low-risk, healthy pregnancies and low PAPP-A level in first trimester screening results is recommended. They should be routinely screened for background medical risk factors and umbilical cord morphology in first trimester scan.
妊娠相关血浆蛋白A（PAPP-A）水平低与不良围产期结局相关。本研究的目的是评估孕11至14周时脐带直径（UCD）、脐静脉和动脉直径（UVD、UAD）、胎盘厚度与PAPP-A水平之间的关系。
对246名妇女在妊娠11至14周进行超声检查时评估UCD、UVD、UAD和胎盘厚度，同时测量颈项透明层（NT）和头臀长度（CRL）。根据PAPP-A百分位数将患者分为两组。第1组包括23名PAPP-A水平低的患者（<0.44中位数倍数[MoM]，<第10百分位数），第2组由223名PAPP-A>0.44 MoM、>第10百分位数的患者组成。用于测量的卡尺放置在血管回声边界的内边缘到内边缘。评估所有血管（脐静脉和两条动脉）的最大截面。胎盘最厚的部分用于测量胎盘厚度。
UCD狭窄（<4.5±0.6 mm）与低PAPP-A水平相关（p=0.02）。两组之间UVD、UAD或胎盘厚度无显著差异。两组之间的孕周、CRL或NT无显著差异。第1组的胎儿出生体重显著较低（p=0.03）。
建议对低风险、健康妊娠且孕早期筛查结果显示PAPP-A水平低的妇女给予更多关注。应在孕早期扫描中对她们进行背景医学风险因素和脐带形态的常规筛查。
